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Segment 2 Registration
After filling the details click on the SUBMIT button.

*indicates required fields 
  *Student's First Name:
  *Student's Last Name:
  *Phone Number:
  *Name of Adult Contact:
  *Email Address:
  *Student's Birth Month:
  *Student's Birth Date:
  *Student's Birth Year:
  *Class Location:
  *Open Dates:
  Other Questions:

After filling the details click on the SUBMIT button.
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